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Psychiatry 2015 > Mood & Anxiety Disorders > Flashcards

Mood & Anxiety Disorders Flashcards

1
Q

The earliest median age of onset is seen in which anxiety disorder?

A

Specific phobia (age 7 = median age of onset).

Note: Specific phobia is the most common mental disorder among women and the second most common among men, second only to substance-related disorders. The rates are 2:1 for women:men, though the ratio is closer to 1:1 for the fear of blood, injection and injury type.

From Ottawa review course and K&S, p. 597

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1
Q

True or false: Bipolar disorder has an earlier age of onset then MDD.

A

True

Canmat guidelines

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2
Q

The Canmat guidelines for pharmacological emergency management of agitation in Bipolar Disorder include what medications?

A

Risperidone (level 2)
Olanzapine (level 2)
Aripiprazole (level 2)
Quetiapine (level 3)

For pts refusing above oral meds: IM olanzapine or ziprasidone (level 2); or a typical antipsychotic IM + benzo

Canmat

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3
Q

Which is untrue of rapid cycling bipolar? It is associated with

  • female sex
  • greater use of antidepressants and lamotrigine
  • greater risk of attempted suicide
  • comorbidity alcohol use
  • better clinical and occupational outcomes
A

Associated with poorer clinical and occupational outcomes

Canmat slides

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4
Q

What is the lifetime prevalence and yearly incidence of major depressive disorder?

A

Lifetime prevalence = 5 - 17% (average 12%)
Yearly incidence = 1.89% women; 1.10% men

Note: “manic episodes are more common in men, and depressive episodes are more common in women”

K&S, p. 528

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5
Q

What is the mean age of onset of MDD?

A

40 years of age (50% of all pts have an onset between age 20-50).

Note: Bipolar I Disorder has a range of onset from age 5-50, with a mean of 30 years of age.

K&S, p. 529

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6
Q

Name the 4 most common Axis 1 Disorders associated with the major mood disorders.

A
  • Alcohol abuse or dependence
  • Panic Disorder
  • OCD
  • Social Anxiety Disorder

K&S, p. 529

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7
Q

The most consistent abnormality in the brain using CT and/or MRI in the depressive disorders include: ?

A

“Increased frequency of abnormal hyper intensities in the subcortical regions, such as periventricular regions, the basal ganglia, and the thalamus…Some depressed patients also may have reduced hippocampal or caudate nucleus volumes.”

K&S, p. 531

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8
Q

The most widely replicated PET finding in depression is: ?

A
  • decreased anterior brain metabolism, which is generally more pronounced on the left side.
  • Furthermore, a reversal of hypofrontality occurs after shifts from depression into hypomania.

K&S, p. 531

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9
Q

Mood disorders involve pathology primarily in which 4 areas of the brain?

A
  1. Prefrontal cortex (PFC) = holds representations of goals and appropriate responses to obtain these goals.
  2. Anterior cingulate cortex (ACC) = integration of attentional and emotional inputs.
  3. Hippocampus = learning, memory, fear conditioning, inhibitory regulation of the HPA axix.
  4. Amygdala = processing novel stimuli of emotional significance and organizing cortical response. Although most research has focused on its relation to fearful or painful simuli, it may be ambiguity or novelty, rather than the aversive nature of the stimulus per se, that brings the amygdala on line.

K&S, p. 532

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10
Q

Family data indicate that if one parent has a mood disorder, a child will have a risk of between ? and ? for a mood disorder.

A

10 and 25%
- if both parents are affected, this risk roughly doubles.

K&S, p. 532

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11
Q

________ disorder is typically the most common form of mood disorder in families of bipolar probands.

A

Unipolar Depression

  • this familial overlap suggests some degree of common genetic underpinnings between these two forms of mood disorders.

K&S, p. 532

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12
Q

Chromosomes ____ and _____ are the two regions with strongest evidence for linkage to bipolar disorder.

A

Chromosomes 18q and 22q

K&S, p. 532

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13
Q

DSM-5: In distinguishing grief from a major depressive episode, it is useful to consider that in grief the predominant affect is feelings of ___ and ___, while in MDE, it is ______ and _________.

A

Grief: feelings of emptiness and loss
MDE: persistent depressed mood and the inability to anticipate happiness or pleasure.

DSM-5

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14
Q

What symptoms are particularly notable in patients with a melancholia specifier?

A
  • severe anhedonia
  • early morning awakening (at least 2 hrs earlier than usual)
  • depression worse in the morning
  • significant anorexia or weight loss
  • profound feelings of guilt (often over trivial events)
  • marked psychomotor retardation or agitation
  • distinct quality of depressed mood

Note: “Antidepressants with dual action on serotonergic and noradrenergic receptors demonstrate greater efficacy in melancholic depression.”

K&S, p. 539/559

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15
Q

What characterizes atypical features in depression?

A
  • overeating
  • oversleeping
  • mood reactivity (mood worse in the evening)
  • long-standing pattern of intepersonal rejection sensitivity
  • leaden paralysis

Note: sometimes referred to as reversed vegetative symptoms or hysteroid dysphoria.
Atypical = younger onset, more severe psychomotor slowing, comorbid panic disorder, substance use, somatization disorder. May have a long-term course, a diagnosis of Bipolar I Disorder, or a seasonal pattern.

K&S, p. 539-541

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16
Q

What are the criteria for the Chronic Specifier in depression?

A

Full criteria for a major depressive episode have been met continuously for at least the past 2 years.

K&S, p. 542

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17
Q

What are the criteria for the Rapid-Cycling Specifier?

A

At leasat 4 episodes of a mood disturbance in the previous 12 months that meet criteria for a major depressive, manic, mixed, or hypomanic episode.
Note: episodes are demarcated either by partial or full remission for at least 2 months or a switch to an episode of opposite polarity.

K&S, p. 542

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18
Q

What is implied by the term ‘forme fruste’ of a depressive episode?

A

“A depressive equivalent is a symptom or syndrome that may be a forme fruste of a depressive episode. For example, a triad of truancy, alcohol abuse, and sexual promiscuity in a formerly well-behaved adolescent may constitute a depressive equivalent.”

Wikipedia = an atypical or attenuated manifestation of a disease.

K&S, p. 543

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19
Q

What is untrue regarding Bipolar II Disorder?

a. less marital disruption than bipolar I disorder
b. earlier age of onset than bipolar I disorder
c. great risk of both attempting and completing suicide than patients with bipolar I disorder and MDD.

A

a. “Although the data are limited, a few studies indicate that bipolar II disorder is associated with more marital disruption…than bipolar I disorder”.

K&S, p. 544

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20
Q

________ and ________ are the most common symptoms of psychomotor agitation in depression.

A

Hand-wringing and hair-pulling

K&S, p. 545

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21
Q

True or False: The interictal changes associated with temporal lobe epilepsy can mimic a depressive disorder, especially if the epileptic focus is on the right side.

A

True.

K&S, p. 548

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22
Q

According to K&S, what are the major goals and mechanisms of change in psychodynamic psychotherapy?

A

To promote personality change through understanding of past conflicts; to achieve insight into defenses, ego distortions, and superego defects; to provide a role model; to permit cathartic release of aggression.

Note: primary techniques = fully or partially analyzing transference and resistance; confronting defences; clarifying ego and superego distortions.

K&S, p. 552

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23
Q

The incidence of severe rash (SJS, TEN) with lamotrigine is _____in 10,000 adults and ___ in 10,000 children.

A

2 in 10,000 adults
4 in 10,000 children

K&S, p. 561

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24
Q

A major defense mechanism used in Dysthymia is ____.

A

Reaction formation

Note: low self-esteem, anhedonia, and introversion are often associated with the depressive character. Persons susceptible to depression are orally dependent and require constant narcissistic gratification. When deprived of love, affection, and care, they become clinically depressed; when they experience a real loss, they internalize or introject the lost object and turn their anger on it and, thus, on themselves.

K&S, p. 563

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25
Q

True or False: no gender differences are seen for incidence rates of Dysthymia.

A

True

Note: affects 5 to 6 percent of all persons in gen pop. More common in unmarried, and young persons and in those with low incomes. More common in women younger than 64 years of age than in men of any age.

K&S, p. 562 (also in the new K&S edition)

26
Q

An estimated 10% of outpatients and 20% of inpatients with borderline personality disorder have a coexisting diagnosis of _________ disorder.

A

Cyclothymic

  • the female-to-male ratio in cylothymia is 3 to 2
  • 50 to 75 % of all pts with cyclothymic disorder have an onset between ages 15 and 25.

K&S, p. 566

27
Q

The major defense mechanism in hypomania is ______.

A

Denial

  • Hypomania is a lack of self-criticism and an absence of inhibitions occurring when a depressed person throws off the burden of an overly harsh superego. The patient avoids external problems and internal feelings of depression.

K&S, p. 566

28
Q

What is untrue about the epidemiology of Panic Disorder?

a. Lifetime prevalence is in the 1 to 4 % range
b. Women are 2 to 3 times more likely to be affected
c. Recent divorce or seperation contributes to development
d. Mean age of presentation is 35

A

d. The mean age of presentation is 25

K&S, p. 588

29
Q

Of those with Panic Disorder, ____ % have at least one other psychiatric disorder.

A

91 %

K&S, p. 588

30
Q

What areas of the brain have been implicated in Panic Disorder?

A

The biological data have led to a focus on:

  • the BRAINSTEM (particularly the noradrenergic neurons of the locus ceruleus and the serotonergic neurons of the median raphe nucleus)
  • the LIMBIC system (possibly responsible for the generation of anticipatory anxiety)
  • the PREFRONTAL CORTEX (possibly responsible for the generation of phobic avoidance)

K&S, p. 589

31
Q

The defense mechanisms used in Panic Disorder and Agoraphobia include: ????

A
  • Repression
  • Displacement
  • Avoidance
  • Symbolization

Note: pts with PD have a higher incidence of stressful life events, particularly loss such as parental separation or death of a parent before age 10.

K&S, p. 590

32
Q

Approximately ___% of women with Panic Disorder have a history of childhood sexual abuse, compared with 31 percent of women with other anxiety disorders.

A

60%

K&S, p. 590

33
Q

In patients with phobias, the primary defense involved is _________.

A

Displacement

  • the sexual conflict (unresolved oedipal situation) is displaced from the person who evokes the conflict to a seemingly unimportant, irrelevant object or situation, which then has the power to arouse a constellation of affects, on of which is called signal anxiety. Other defence mechanisms included avoidance, symbolization and repression.

K&S, p. 598

34
Q

What does Ailurophobia and Cynophobia refer to?

A

Fear of cats and dogs, respectively.

Note:

  • acrophobia = fear of heights
  • mysophobia = fear of dirt and germs

K&S, p. 600

35
Q

Hypochondriasis is the fear of _______ a disease, whereas specific phobia of the illness type is the fear of ______ the disease.

A

Hypochondriases = fear of having the disease
Specific phobia = fear of contracting the disease

K&S, p. 602

36
Q

Specific phobia exhibits a bimodal age of onset, with a childhood peak for ___________ phobia, and an early adulthood peak for _________ phobia.

A

Childhood = animal, natural environment, blood-injection-injury phobias
Early adulthood = situational and other phobias

K&S, p. 602

37
Q

What is untrue of OCD:

a. The incidence of Tourette’s disorder in pts with OCD is 5-7%.
b. The incidence of tics in pts with OCD is 20-30%.
c. Lifetime prevalence of OCD is 2-3%.
d. OCD is the 7th most common psychiatric diagnosis.
e. The mean age of onset is 20 (19 in men, 22 in women)

A

d. OCD is the 4th most common psychiatric diagnosis after phobias, substance-related disorders, and MDD.

K&S, p. 605

38
Q

Which brain areas are implicated in OCD?

A

Increased activity in the frontal lobes, the basal ganglia (especially the caudate), and the cingulum. CT and MRI studies have found bilaterally smaller caudates.

  • The involvement of these areas in the pathology of OCD appears more associated with the corticostriatal pathways than with the amygdala pathways that are the current focus of much anxiety disorder research.

K&S, p. 605

39
Q

In classic psychoanalytic theory, OCD was termed obsessive-compulsive neurosis and was considered a regression from the _____ phase to the _____ phase of development.

A

oedipal to the anal psychosexual phase.

“When pts with OCD feel threatened by anxiety about retaliation for unconscious impulses or by the loss of a significant object’s love, they retreat from the oedipal position and regress to an intensely ambivalent emotional stage associated with the anal phase. The ambivalence is connected to the unraveling of the smooth fusion between sexual and aggressive drives. The coexistence of hatred and love toward the same person leaves patients paralyzed with doubt and indecision”.

K&S, p. 607

40
Q

Name the 4 most common symptom patterns in OCD.

A

Most common = Contamination obsessions
2nd = Pathological doubt (doubt followed by checking)
3rd = Intrusive thoughts
4th = Symmetry

K&S, p. 609

41
Q

Why is the Clomipramine the TCA of choice for the treatment of OCD?

A

Of all the tricyclic and tetracyclic drugs, it is the most selective for serotonin reuptake versus norepinephrine reuptake and is exceeded in this respect only by the SSRI’s. The potency of serotonin reuptake of clomipramine is exceeded only by sertraline and paroxetine.

K&S, p. 611

42
Q

What psychosurgical procedures are there for OCD?

A

A common psychosurgery for OCD is cingulotomy, which is successful in treating 25-30% of tx-unresponsive pts. Other surgical techniques include a sub caudate tractotomy (capsulotomy), and nonablative surgery such as DBS involving indwelling electrodes in various basal ganglia nuclei.
- the most common complication of psychosurgery is the development of seizures (controllable with phenytoin).

K&S, p. 612

43
Q

True or False: Patients who have cardiomyopathy may have the highest incidence of panic disorder secondary to a general medical condition.

A

True

  • one study reported that 83% of pts with cardiomyopathy awaiting cardiac transplantation had panic disorder symptoms. Increased noradrenergic tone in these pts may be the provoking stimulus for panic attacks.

K&S, p. 628

44
Q

What is the most common severe brain illness?

A

Bipolar Affective Disorder

Lecture Nov/2014 (R. Macintyre; WHO stats)

45
Q

What is the most common discrete neurological co morbidity in bipolar disorder?

A

Migraines

Lecture Nov 2014 (R. Macyntyre)

46
Q

Individuals with bipolar mania with mixed features have a high rate of what medical disease?

A

Cardiovascular Disease

Lecture Nov 2014 (R. Macintyre)

47
Q

True or False: the number of suicides in Canada is about six times the murder rate.

A

True

StatsCan data: 3890 suicides and 610 murders in 2009
- suicides = 11.5/100,000

uOttawa/StatsCan

48
Q

When suicide rates are compared across age groups, persons aged ___ to____ have the highest rate.

A

40 to 59 yrs = 45% of all suicides

  • 35% (age 15-30)
  • 19% (over age 60)

StatsCan website (2009 data)

49
Q

Among those aged __ to ___, suicide was the second leading cause of death, preceded only by accidents.

A

15 to 34 yrs

  • The number of teen suicides is about 6% of the total number of suicides.

StatsCan webste (2009 data)/uOttawa

50
Q

Of those who engage in self-harm; approximately __ % will commit suicide within the next year.

A

1%

  • 25% of people who commit suicide have a history of self-harm in the preceding year.
  • Over 10 years, 10% of those who self-harm will die (half from suicide; half from mortality due to other causes)

uOttawa

51
Q

Increased or decreased serotonin in the brains of those who suicide?

A

decreased

uOttawa

52
Q

What are the 3 components in Joiner’s model of suicide?

A
  • thwarted belongingness
  • perceived burdensomeness
  • capability for suicide

uOttawa

53
Q

True or False: most people who commit suicide are high risk.

A

False
- 90% are low risk

uOttawa

54
Q

True or False: people who present with cutting havea a lower rate of suicide than those who present with overdoses.

A

False

uOttawa

55
Q

Which is untrue about risk factors for suicide in depression?

a. male gender
b. family hx of psych disorder
c. previous self-harm
d. more protracted depression
e. hopelessness
f. comorbid disorders
g. substance abuse

A

d. more severe depression

uOttawa

56
Q

The anterior cingulate cortex plays a role in ?

A
  • rational cognitive functions such as reward anticipation, decision-making, empathy, and emotion.

uOttawa

57
Q

What are the first-line and second-line psychotherapies for acute MDD according to the 2009 Canmat guidelines?

A

First line
CBT (level 1)
IPT (level 1)

Second line
Bibliotherapy
Behavioural activation
CBASP
Computer-assisted CBT
Telephone-delivered CPT & IPT
58
Q

What are the first and second line psychotherapies recommended for the maintenance phase of MDD according to the 2009 Canmat guidelines?

A 
First line:  CBT
Second line:
Behavioural activation
CBASP
IPT
MBCT
59
Q

Durkheim divided suicides into 3 social categories. Explain.

A

Egoistic: applies to those who are not strongly integrated into any social group
Altruistic: those susceptible to suicide stemming from their excessive integration into a group, with suicide being the outgrowth of the integration.
Anomic: applies to persons whose integration into society is disturbed so that they cannot follow customary norms of behaviour

Juveria notes

60
Q

True or False: In Dysthymia, criteria for a hypomanic episode have not been met for 2 years prior to the diagnosis.

A

False.
- “There has never been a manic episode or hypomanic episode, and criteria have never been met for cyclothymic disorder”.

DSM-5

61
Q

About 50% of patients with dysthymia experience an insidious onset of symptoms before age ___ ?

A

25 years

K&S

62
Q

Studies of dysthymia indicate that about 20% progressed to MDD, 15% to bipolar II disorder, and fewer than __ % to bipolar I disorder.

A

5%

K&S

Psychiatry 2015 (9 decks)

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